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Multiple Personality Disorder (MPD) / Dissociative Identity Disorder... guidetopsychology.com | Borderline Personality Disorder and Narcissistic Personality Disorder -... ccspublishing.com | Shame and Avoidant Personality Disorder - Personality Disorders mentalhelp.net | Borderline Personality Disorder and Narcissistic Personality Disorder -... medical-library.org |
Not to be confused with Avoidant personality disorder.
Antisocial personality disorder (ASPD or APD) is defined by the American Psychiatric Association's Diagnostic and Statistical Manual as "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood."[1] The individual must be age 18 or older, as well as have a documented history of a conduct disorder before the age of 15.[1] People having antisocial personality disorder are sometimes referred to as "sociopaths" and "psychopaths", although some researchers believe that these terms are not synonymous with ASPD.[2] [edit] HistoryThe history of the origins of antisocial personality disorder are closely related to the history of psychopathy - see history of psychopathy. [edit] SymptomsCharacteristics of people with antisocial personality disorder may include:[3]
[edit] Diagnostic criteria (DSM-IV-TR = 301.7)The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines antisocial personality disorder (in Axis II Cluster B) as:[1]
Deceit and manipulation are considered essential features of the disorder. Therefore, it is essential in making the diagnosis to collect material from sources other than the individual being diagnosed.[7] It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria. [edit] CriticismResearchers have heavily criticized the ASPD DSM-IV criteria because not enough emphasis was placed on traditional psychopathic traits such as a lack of empathy, superficial charm, and inflated self appraisal. These latter traits are harder to assess than behavioral problems (like impulsivity and acting out). Thus, the DSM-IV framers sacrificed validity for reliability. That is, the ASPD diagnosis focuses on behavioral traits, but only limited emphasis is placed on affective and unemotional interpersonal traits. Many have argued[weasel words] that psychopathy/sociopathy are incorrectly put together under ASPD. These clinicians and researchers[who?] are upset that an important distinction has been lost between these two disorders. In other words, ASPD and psychopathy are considered to be the same, or similar. However, they are not the same since antisocial personality disorder is diagnosed via behavior and social deviance, whereas psychopathy also includes affective and interpersonal personality factors.[8] Also, ASPD, unlike psychopathy, does not have biological markers confirmed to underpin the disorder.[citation needed] Other criticisms of ASPD are that it is essentially synonymous with criminality. Nearly 80%–95% of felons will meet criteria for ASPD — thus ASPD predicts nothing in criminal justice populations. Whereas, psychopathy scores (using the Hare Psychopathy Checklist-Revised (PCL-R)) is found in only ~20% of inmates and PCL-R is considered one of the best predictors of violent recidivism.[citation needed] Also, the DSM-IV field trials never included incarcerated populations. The official stance of the American Psychiatric Association as presented in the DSM-IV-TR is that psychopathy and sociopathy are obsolete synonyms for antisocial personality disorder. The World Health Organization takes a similar stance in its ICD-10 by referring to psychopathy, sociopathy, antisocial personality, asocial personality, and amoral personality as synonyms for dissocial personality disorder.[citation needed] [edit] Diagnostic criteria (ICD-10) - dissocial personality disorderThe World Health Organization's ICD-10 defines a conceptually similar disorder to antisocial personality disorder called (F60.2) Dissocial personality disorder.[9]
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria. [edit] Millon's variationsTheodore Millon identified five variations of antisocial [12]. Any individual antisocial may exhibit none, one or more than one of the following:
[edit] Differential diagnosis: associated and overlapping conditionsThe following conditions commonly coexist with antisocial personality disorder:[13]
[edit] Prevalence (epidemiology)Antisocial personality disorder in the general population is about 3% in males and 1% in females.[1][13] It is seen in 3% to 30% of psychiatric outpatients.[1][13] The prevalence of the disorder is even higher in selected populations, such as people in prisons (who include many violent offenders).[14] Similarly, the prevalence of ASPD is higher among patients in alcohol or other drug (AOD) abuse treatment programs than in the general population (Hare 1983), suggesting a link between ASPD and AOD abuse and dependence.[15] [edit] Causes (etiology)The exact cause of ASPD is not known, but biological or genetic factors may play a role. Brain structure deregulation, specifically within the prefrontal cortex and amygdala, plays an important contribution. If the parent of an individual has had the disorder, that individual has a greater chance of having the disorder. A number of environmental factors in the childhood home, school, and community may also contribute to the disorder, such as losing respect or "giving up" on authority figures after observance of their hypocrisy and/or misbehaviors. Robins (1966) found an increased incidence of sociopathic characteristics and alcoholism in the fathers of individuals with antisocial personality disorder. He found that, within such a family, males had an increased incidence of ASPD, whereas females tended to show an increased incidence of somatization disorder instead.[16] Bowlby (1944) saw a connection between antisocial personality disorder and maternal deprivation in the first five years of life. Glueck and Glueck (1968) saw reasons to believe that the mothers of children who developed this personality disorder usually did not discipline their children and showed little affection towards them. But it is also important to point out that correlation does not imply causation. Adoption studies show that both genetic and environmental factors can contribute to the development of the disorder. These studies have also shown that genetic factors are more important for adults with the disorder, while environmental factors are more important in antisocial children. [16][17] Currently, genetic and environmental factors are thought to contribute to the organic causes of the disorder, namely, deregulation of the amygdala and orbitofrontal cortex. The prefrontal lobes are responsible for forming goals and objectives, coordinating skills, and evaluating our actions. The OFC of the prefrontal lobes has connections to the amygdala, is part of the limbic system, and is specifically noted for regulating and modulating stress/arousal responses, as well as response-reversal. [18][19] Antisocial individuals, because of an impaired amygdala show impaired initial response learning. Additionally, when psychopaths and amygdalar-lesioned patients are presented with a peripheral emotional image (e.g. a picture of a corpse, or the sound of a crying baby) while completing a simple task, their performance remains relatively unaffected. They show impaired recognition of, and reaction to, fearful facial and vocal affect. In general, the combination of an inattentiveness to emotionally charged stimuli (whether presented in full view or as a peripheral distraction) as well as an inability to shift attention to an alternative route of reward (and thus, avoid punishment) can account for much of a APD individual’s deviant behavior. They do not notice emotion and are unable to empathize—and thus feel unaffected when their actions have detrimental effects on other people. They also continue to commit acts of crime or violence long after the rewards have stopped and the punishment has begun (e.g. repeat offenders who have been incarcerated multiple times)[20]. They also are quick to display aggressive and impulsive behavior. This reactive antisocial aggression is perhaps in part a result of elevated levels of frustration experienced when they are unable to modify their behavior in the ever-changing environment.[21] [edit] Potential markersIn the past, the presence of three behavioral markers, known as the Macdonald triad, was found in some children who went on to develop sociopathy. The triad consists of bedwetting, a tendency to abuse animals, and pyromania.[22] The ASPD etiology is currently associated with abusive, chaotic, or emotionally deprived home environments and with low socioeconomic status and urban settings. However, there are concerns that this diagnosis is misapplied to individuals in which this behavioral strategy is contingent with economic or other survival[1]. ASPD is also highly co-morbid with ADHD and Substance-Abuse Disorders[1]. Current neuropsychology recognizes that in addition to the outwardly antisocial behaviors (lying, manipulation, and disregard for the law or other people), ASPD individuals show impairment in both their orbitofrontal cortex (problems with task-switching and other executive functioning) and their amygdala (shown through their impaired fear response and emotional reaction)[20][23]. ASPD patients also have poor fear conditioning (which implicates the hippocampus) and show a general under-arousal to stimuli[24]. Indeed, in children as young as three, a slower heart rate correlates with aggression (though not specifically psychopathy) [25]. [edit] Treatment
To date there have been no controlled studies reported which found an effective treatment for ASPD[26]. Some studies have found that the presence ASPD does not significantly interfere with treatment for other disorders, such as substance abuse[27], although others have reported contradictory findings[28]. [edit] See also
[edit] References
[edit] External links
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